Ice massage is safe, effective, and inexpensive in controlling several kinds of pain. In sports medicine, it is used to relieve musculoskeletal aches and pains caused by strains and tension. Baseball pitchers typically put their pitching arm in a bucket of ice water after a game, to decrease ache and swelling and to prevent pains that might develop otherwise.
Why ice massage is effective has not been understood until recently, though it was known that it produces a local constriction of blood vessels, makes the area feel "numb" and it hurts, producing aching and burning pain. Recent studies suggest that it may act like acupuncture or intense transcutaneous electrical nerve stimulation (TENS).
In a study by Melzack et al. in 1980, patients suffering from acute dental pain were treated with ice massage of the back of the hand on the same side of the body as the pain, at what is known as the Hoku acupuncture point, located at the vertex of the web between the thumb and the index finger. The ice massage was found to halve the intensity of that dental pain for most patients, and to be more effective than tactile massage.
These observations led to another study by Melzack et al. in 1980, in which the relative effectiveness of ice massage and TENS were studied for the relief of low-back pain. These two methods were found to be about equally effective: about 65% of patients obtained pain relief greater than one-third. Ice massage was more effective than TENS for some patients, while TENS was more effective for others. Ice massage could be used as an additional sensory-modulation method, alternating with TENS to overcome adaptation effects.
In a further study by Melzack and Bentley in 1983, patients suffering acute dental pain were treated with ice massage of (1) the Hoku acupuncture point on the back of the hand, or (2) the lateral surface of the arm near the elbow. Four groups of patients received the ice massage at one of the points on the side ipsilateral or contralateral to the dental pain. A control group received tactile massage of the ipsilateral Hoku point. Changes in pain intensity produced by the procedure were measured by a McGill Pain Questionnaire. Pain intensity was significantly decreased by about 40-50% after ice massage of the ipsilateral hand, the contralateral hand or the contralateral arm. However, ice massage of the ipsilateral arm had no significantly better effect than tactile massage of the ipsilateral hand.
The effectiveness of ice massage of the contralateral hand is consistent with Chinese literature on acupuncture, which states that intense stimulation of certain points are particularly effective for relieving pain at or near distant sites.
Data demonstrate the importance of recognizing individual differences in the distribution of trigger or acupuncture points and the need to find them by careful exploratory palpation in each person.
The most common use of ice massage, however, is to apply the ice directly to the painful area. In the classic studies in this field, ice cubes held in gauze-pads or in a strip of cloth were moved thereon in a circular motion of the painful area.
An excellent review on "The Therapeutic Use of Cold" by Mennell (1975) describes the direct application of ice as well as the use of cold-sprays for "ice-and-stretch" treatment.
An earlier clinical study by Grant (1964), based on experience with more than 7000 outpatients, describes the use of direct application of ice for shoulder-neck pain, and low-back pain. Grant reported that initially the patient had a sensation of cold which tended to become more uncomfortable, and to be replaced by a burning sensation. In most patients, this was followed by an aching sensation for a short time. Massage was continued beyond this point to a state of analgesia and then discontinued. Then the patient was given a program of range of motion and mobilization exercises. If the pain relief was not enough to enable good patient performance in the exercise program, the ice massage was repeated. Such a second period of icing was rarely required, but at times even a third application was given.
For most areas the ice massage took from five to seven minutes. Areas with considerable fatty subcutaneous tissue required a longer period of icing. Very thin patients commonly required a shorter icing period and tended to complain more about discomfort, but they also tended to show the best clinical results.
A later study by Kirk and Kersley (1968) examined the relative effectiveness of "heat and cold in the physical treatment of rheumatoid arthritis of the knee" and reported that no applications of crushed ice in a damp towel "were acceptable to patients and were associated with a greater relief of pain and stiffness than hot applications." However, both were equally effective on objective measurements of movement.
Other studies (Halliday Pegg et al., 1969; Stangel, 1975) reported efficacious results for arthritic and other pains.
A discovery, based on clinical observation, was made in the 1930's by Janet Travell (who later became President John F. Kennedy's personal "Physician in the White House"). Dr. Travell discovered that many severe musculoskeletal pains were associated with localized spots--"trigger points"--which were highly sensitive to touch. When pressure was applied to the spots, they evoked pain in a distinct area which usually surrounded the spot or was near it but might be at a considerable distance away. Beneath the trigger point, palpation often revealed a band of muscle in spasm. Dr. Travell found that by "dry needling" the spot or by applying a cold spray, it became possible to relieve the pain of the trigger spot as well as the pain in the larger area of referred pain. Thus, stimulation of trigger points by a variety of inputs appears to be capable of relieving pain.
This area of investigation led to the hypothesis by Melzack in 1975 and 1977 that acupuncture points and trigger points actually represent the same physiological phenomenon. To test this hypothesis, Melzack, Stillwell and Fox (1977) examined the distribution of both sets of points (and the related areas of pain) and found an astonishingly close correspondence--71%--between them. This close correlation suggests that trigger points and acupuncture points for pain, though discovered independently and labelled differently, represent the same phenomenon and can be explained in terms of similar underlying neutral mechanisms.
These results suggest that ice massage, which is an extremely simple procedure, can be used for a variety of clinical pain problems. A patient can, for example, easily be shown how to rub ice over the appropriate areas of the hand to diminish toothache.
The fact that intense inputs of almost any kind tend to diminish pain had led to the labelling of this phenomenon as hyperstimulation analgesia; that is, relief of pain by intense (sometimes painful) stimulation.
The mechanisms for the effects of ice massage appear to lie at several levels:
1. Ice massage produces a local constriction of blood vessels and consequently may diminish swelling, decrease local bleeding after an injury, and may slow down the release of bradykinin, histamine and other pain-eliciting substances.
2. Interaction among fibers of different sizes at the level of the dorsal horn of spinal cord have been extensively documented (see Melzack and Wall, 1983; Wall, 1984).
3. Areas in the brainstem can exert an inhibitory control over transmission.
With all these desirable qualities, still it must be admitted that ice cubes, crushed ice, and cloth-wrapped ice are all awkward to use, and difficult to handle. When the ice melts, it gets everything wet that it melts on or through. The present invention is directed toward obtaining the beneficial effects of ice massage in a much more convenient manner. It enables use of cold massage with a simple and effective tool.